Dr. Sunil Sahai

Herniated disc, bulged disc, protruded intervertebral disc (PIVD) are the different names of one condition. This is a condition where- disc in between the two vertebral bodies starts peeping out on one side- anterior or posterior. These discs are just like the bags filled with liquid material, which work like shock-absorbent. There are several hard bony vertebrae in the vertebral column and there is plenty of movements with these vertebrae. When we look on one side to other side, we look upwards, downwards or we twist and even we bend forward or backward in each and every condition, there will be a movement in these bones, these discs decide the free movements of the spine. Along with this- when we walk or run there will be shocks and jerks to all these bones and these bags decide that there wont be any kind of jerks in between the bones. So, these discs are of multiple uses.

Our spine is inverted “S” shaped. There are two main curvatures in the spine which are free to move- Cervical and Lumbar curvatures. These curvatures of the spine are maintained due to the spaces in between the two vertebrae. Whenever there is a loss or change (specially reduction) of this space between two vertebrae- pressure will be exerted on the intervertebral discs. This uneven pressure on the disc causes- protrusion/bulge/herniation of the disc- this is the condition known as SLIPPED DISC, in layman language. Why does disc slip

Generally, slipped disc condition is diagnosed by its signs and symptoms. When slipped disc starts exerting pressure on the nerves surround the disc- the nerve will be excited which gives sensation of- Pain, Burning or Numbness in the related area of the nerve. This sensation can travel long far away to the areas, which are being supplied by the nerve and can be limited to a particular location in neck or back even. Sign & Symptoms of Slipped Disc.

Ayurveda about Slipped Disc

Where modern medical (Surgical) sciences believes that this is a problem of just bones and joints of the vertebral disc besides this Ayurveda takes a “Wholistic” (Complete and wholesome) approach towards this and tells that this is a problem at three levels-

1. Mamsa Dhatu, Asthi Dhatu, Majja Dhatu!
2. These are different tissue levels according to Ayurveda- Mamsa is muscles, Asthi represents bones and the Majja denotes everything which is in between and in the bones.
3. Mamsa (the muscles) starts stiffening due to the dryness – improper diet and imbalanced lifestyle and deteriorate the curvature of the spine- which leads to the deterioration of the intervertebral discs.
4. Asthi (the bony tissue) is affected due to the muscles.
5. Majja (the disc and the neural tissue- spine) is compressed due to the pressure and all effects.

So, we need to treat the condition, wisely and in a wholesome manner, rather just to removal of the protruded tissues (Laminotomy) and this is the basic reason- there are risks associated to the surgery of the spine and in almost more than 45% cases patients had to go for a second surgery to stay pain free. Why Surgery for spine doesn’t succeed. Secondly, this is a mechanical problem so medicines alone can give you temporary relief rather than the cure-  So better you save your money and invest it on complete cure for the problem, rather than just taking the pain killers and medicines which were indicated in epilepsy to just reduce the signs and symptoms.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The human hand has multiple bones, tendons, ligaments and muscles which in unison help us to grip things and manipulate other objects to do our work. Within the wrist lies a narrow passageway on the palm side which houses the main nerve for movement of the nine tendons. These tendons help us to move our fingers individually and grip things or accomplish any task we want with our hands.

What is Carpal tunnel syndrome?
Carpal tunnel syndrome is a condition where this nerve gets pinched due to a variety of factors and may have adverse effects. Some of the symptoms include tingling, numbness and pain with movements of the arm.

Causes of Carpal Tunnel Syndrome:
The nerve within the wrist which is known as the median nerve can be pinched due to a variety of factors:

1. Movements where the wrists are always higher and in an angle: Repetitive movements of the wrists where the hands are always at a lower angle, can increase the chances of carpal tunnel syndrome. This is usually a workplace related problem and thus be caused by bad hand posture.
2. Medical Conditions: There are certain medical conditions that may also trigger the onset of carpal tunnel syndrome such as diabetes, thyroid, menopause and other problems.
3. Pregnancy: Pregnancy has also known to cause carpal tunnel disorder as it can alter the balance of fluids within your body. However, other factors could also put your fluids in imbalance and cause problems with the median nerve.
4. Conditions that may cause inflammation: Certain conditions such as rheumatoid arthritis can cause the inflammation within the joints which might lead to the median nerve being pinched which in turn might lead to carpal tunnel syndrome.

Some Preventive Measures from Carpal Tunnel Syndrome:

1. Breaks from repetitive work: It is important for your wrists to have a break when you are doing repetitive tasks that might cause carpal tunnel syndrome. Relax and stretch your muscles within the break time
2. Wear wrist splints: These are support devices which can help correct problems for repetitive actions throughout the day while you are sleeping.
3. Take pain reliever if you start having chronic pains: If your wrist pain is not letting you functions normally, take a pain reliever such as ibuprofen or aspirin and go to a doctor as soon as possible for a more thorough treatment. If you wish to discuss about any specific problem, you can consult an orthopaedist.

SPINAL ARACHNOIDITIS

Arachnoiditis of the spinal cord is a non specific inflammatory disease of the arachonoid membrane which is characterized pathologically by thickening of the arachnoid membrane with adhesion or adherence to the dura matter and manifested clinically through roots or radiclar signs and symptoms.  

CLINICAL FEATURES

Arachnoiditis is usually seen in 40 to 60 years of age but rarely below 20years.

Onset: it can be acute or sometimes it may take months.Pain: pain is usually localized type with a burning character. Later the painstarts radiating down the lower limb due to nerve root irritation.

Paresthesia: this also takes place due to irritation of the sensory nerve  roots.

Sensory loss: this occurs when the sensory nerve roots get completely blocked.

Muscle weakness with atrophy: although the anatomy of the motor nerve roots make them less prone to get compressed, it can happen in the later stage which will then give rise to weakness and wasting of the corresponding muscles. 

MANAGEMENT 

The medical management usually consists of corticosteroids in acute stage of inflammation. NSAID for pain relief and inflammation.

Surgical management consists of Rhizotomy in cases of unbearable pain.Surgical decompression for removal of cyst. 

PHYSIOTHERAPY MANAGEMENT comprises of 

Moist heat mainly for reducing the muscle spasm. 

SSF also relieves pain by reducing spasm  and by increasing the blood supply to the area. In case of radiating pain due to involvement of nerve roots the patient may be treated with TENS. Even in     cases of paresthesia TENS is usually used. 

Laser has been found to reduce the inflammation and also break the adhesion in the deep seated structures  which helps in setting free the irritation on the nerve roots thereby     relieving the discomforts of the patient. 

Active exercises like static exercises for the abdominus, back extensor, gluteus and quadriceps helps in reducing   pain in the initial stages and also maintains the tone in the muscles. 

Dynamic exercises may be started once the  pain level comes within the patient’s tolerance level. These exercises may be continued by the patient throughout the life for preventing any chances     of recurrence. 

SLR: Active and passive SLR is given to  lengthen the neural structures and relieve the tension in them. This is a type of neural mobilization that helps in relieving the signs of   radiculopathy. 

Gait training in cases of muscular weakness.